Tuesday, April 29, 2014

To the person on the street, everything seems to be changing on an almost daily basis. How can the ordinary person begin to understand all the ramifications of the Affordable Care Act? What is a person to do when, even though they have health insurance, they are potentially facing high medical bills that are not addressed by their plan?

Some people with a high deductible plan end up having to pay thousands of dollars in co-pays and deductibles. Are there other options for them or ways they can get discounted services? Or maybe they have seen a doctor out-of-network, or for some reason their condition is not addressed by their health insurance. What are they to do?

"When the government takes over health care and bans private health insurance, what can we expect? We can expect rationing of medical care.

In fact, in the New York Times article below, leftist utilitarian philosopher Peter Singer openly advocates rationing. He does it by arguing that health care is already "rationed" in the free market, it is just "rationing by price."

This is an inexcusable abuse of the language. "Rationing by price" is a contradiction in terms, because prices are the opposite of rationing.

The essence of a price is voluntary exchange. A price is the result of a negotiation between a willing buyer and a willing seller, with each party acting on his own judgment about his best interests.

So if you decide to pay lower premiums for less extensive insurance coverage, or to forgo an extremely expensive treatment that will only extend your life by a few months, so that you can leave more of your savings to your loved ones, these vital decisions are under your control and are directed according to your judgment of the risks and of the relative values involved.

You are never denied care-if you are actually willing to do what is necessary to obtain it.

Prices are implicitly based on an ethics of individualism-the idea that it is the individual's right to make his own decisions and his responsibility to support himself.

Rationing, by contrast, is an artificial shortage created by coercion.

It consists of the government telling you that you cannot have certain kinds of medical care because some board of bureaucrats has decided that it is not "cost-effective."

Rationing is implicitly-and explicitly-based on an ethics of collectivism.

I don't recommend reading the whole article below, because reading a contemporary philosopher is like sticking your head in a cotton candy machine. But if you do choose to read it, you may notice that it never looks at medical care from the perspective of the individual making rational decisions about costs and benefits for his own life.

It always implicitly looks at health care from a collectivist perspective: the perspective of bureaucrats making decisions about the cost of your medical care "to society."

The term that sums up this collectivist outlook is the "quality adjusted life year"-the pseudo-mathematical term for a government bureaucrat's decision concerning whether your life is worth continuing or not, based upon your age, your prognosis, and some bureaucratic formula that quantifies your "quality of life."

"Quality adjusted life year" is the term that tells you that the most profound decisions concerning your own life have been taken out of your hands. Get ready to hear it a lot- and to live and die by it- if Obama and the Democratic leaders in Congress get their way.

"Why We Must Ration Health Care," Peter Singer, New York Times, July 15

"You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much? If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn't going to be good. But suppose it's not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man-and everyone else like him-with Sutent, your premiums will increase.

Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone's life?

If there is any point at which you say, "No, an extra six months isn't worth that much," then you think that health care should be rationed.

In the current US debate over health care reform, "rationing" has become a dirty word .

Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for.

But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.

The case for explicit health care rationing in the United States starts with the difficulty of thinking of any other way in which we can continue to provide adequate health care to people on Medicaid and Medicare, let alone extend coverage to those who do not now have it. Health-insurance premiums have more than doubled in a decade, rising four times faster than wages.

In May, Medicare's trustees warned that the program's biggest fund is heading for insolvency in just eight years. Health care now absorbs about one dollar in every six the nation spends, a figure that far exceeds the share spent by any other nation .

Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse. If we ration we won't be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend. When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money.

The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?...

This is the basis of the quality-adjusted life-year, or QALY, a unit designed to enable us to compare the benefits achieved by different forms of health care.

The QALY has been used by economists working in health care for more than 30 years to compare the cost-effectiveness of a wide variety of medical procedures and, in some countries, as part of the process of deciding which medical treatments will be paid for with public money.

If a reformed US health care system explicitly accepted rationing, as I have argued it should, QALYs could play a similar role in the US..The Tracinski Letter

Thursday, April 10, 2014

““Medicare’s release of data on physician payments serves no purpose except to further the federal government’s war on doctors. Doctors are the scapegoats for the program’s bankruptcy....What Medicare does not tell the public is that hospitals are paid much more than physicians for the very same drugs or treatments. This is driving independent doctors out of practice, and patients into hospitals that are likely to care much more about their bottom line than about giving the best treatment to individual patients."Medicare Data Release Counterproductive, Misleading